Perhaps you've heard of the new proposal from HHS to help all those who need to sign up for health care through the Obamacare exchanges. They want to develop a new position, called a Navigator. Yes, just what we need - more govt workers.

And not just a few of them. If the figures for California's request are extrapolated out, it comes to over 560,000 new govt employees.

The insanity of this program is just beginning...

quote: ObamaCare’s Costly GPS: Tens of Thousands of "Navigators"

With just a compass, some charts, and an hourglass, Christopher Columbus was able to navigate sailing ships to the New World and back multiple times. By contrast, reports the Washington Examiner’s Paul Bedard, it is going to take “tens of thousands” of people, each possibly earning “$20 an hour or more,” to help Americans navigate ObamaCare.

The Department of Health and Human Services (HHS) has proposed a rule laying out the requirements for the healthcare law’s insurance “navigators,” whose job it will be to assist Americans who don’t have coverage through their employers in purchasing insurance through state exchanges. Buying coverage is scheduled to commence in January, but the websites and call centers for the exchanges are supposed to go active October 1, and that’s when the navigators will first be needed. (Of course, those dates could very well be pushed back: The feds’ small-business exchange has already been delayed a year, and HHS is also known to be a few months behind on the state exchanges, many of which it will have to run.)

There is little question that people are going to need a great deal of help finding their way through the labyrinthine legislation. The two laws comprising ObamaCare come to nearly 1,000 pages, and the regulations issued under it are already “well over twice as long as the Guinness World Record for the longest novel,” according to Americans for Limited Government. A draft version of the federal government’s application for insurance is 15 pages long for a family of three and includes an additional 61-page questionnaire for determining eligibility for financial assistance. The proposed navigator rule itself runs to 63 pages.

Just who is eligible to become a navigator? Although the rule declares that navigators “must not have a conflict of interest during their term” and “must provide information and services in a fair, accurate, and impartial manner,” it provides little other guidance. “The rules allow navigators to come from the ranks of unions, health providers and community action groups such as ACORN and Planned Parenthood,” Bedard states. In fact, they require each exchange to have “at least two different types of entities as Navigators, one of which must be a community and consumer-focused non-profit group.”

How many navigators will be needed? The final number has not yet been determined, but according to Bedard, California alone has requested 21,000 of them. It’s no exaggeration to suggest that there may be hundreds of thousands of these tax eaters when all is said and done.

And taxes they will consume. HHS estimates that navigators will make anywhere from $20 to $48 per hour, depending on their positions. Assuming California got its 21,000 navigators and they all made just $20 an hour for a 40-hour week, they would cost taxpayers over $873 million a year — and that’s for just one state. The day after the proposed rule was released, Rep. Kenny Marchant (R-Texas), a member of the House Ways and Means Committee, sent a letter to HHS Secretary Kathleen Sebelius expressing his concern over the navigators’ “inflated hourly wages,” particularly “at a time when thousands of current federal employees are being placed on furloughs to reduce our budget deficit.” (An administration official told Bedard that the $20-per-hour assumption used in the rule “is an estimate, not a recommendation or a requirement” and that “states and organizations are not required by the federal government to set any payment levels for these employees.”)

Additionally, taxpayers will have to foot the bill for translators for non-English-speakers who seek insurance on an exchange. The proposed rule requires exchanges and navigators to “provide consumers with information and assistance in the consumer’s preferred language, at no cost to the consumer, which would include oral interpretation of non-English languages and the translation of written documents in non-English languages when necessary to ensure meaningful access.”

The exchanges themselves are supposed “to have a strong customer-service component, including call centers and physical offices,” according to The Hill. This, too, will undoubtedly take taxpayers for a pretty penny — and provide customer service similar to that of the Internal Revenue Service.

Then there’s the matter of voter registration. The draft ObamaCare application asks the applicant if he would like to register to vote; if so, it directs him to a voter registration form. Republicans are none too happy with this, fearing that it could be used to encourage people to register as Democrats — especially since Democrat-aligned activists may well be serving as navigators — or to retaliate against those who don’t. (Democrats might want to consider this, too: At some point a non-Democrat will move into the White House and become privy to the data HHS has collected.) Rep. Charles Boustany, Jr. (R-La.), chairman of the House Ways and Means Oversight Subcommittee, wrote to Sebelius on March 25, seeking more details on the voter-registration matter. In his letter he reminded her that the Affordable Care Act (ObamaCare) does not mention voter registration and that the Paperwork Reduction Act “requires that Federal agencies gather only appropriate information as required by legislation.”

Navigating ObamaCare is going to be a costly, labor-intensive, intrusive, and politically charged task. In no conceivable way does it improve the quality or reduce the cost of healthcare. It does, however, vastly extend the reach of the federal government and the party that controls its executive branch. And that, more than anything else, explains why the law was passed and why it is proving so difficult to repeal.

quote:Perhaps you've heard of the new proposal from HHS to help all those who need to sign up for health care through the Obamacare exchanges. They want to develop a new position, called a Navigator. Yes, just what we need - more govt workers.

And not just a few of them. If the figures for California's request are extrapolated out, it comes to over 560,000 new govt employees.

The insanity of this program is just beginning...

quote: ObamaCare’s Costly GPS: Tens of Thousands of "Navigators"

With just a compass, some charts, and an hourglass, Christopher Columbus was able to navigate sailing ships to the New World and back multiple times. By contrast, reports the Washington Examiner’s Paul Bedard, it is going to take “tens of thousands” of people, each possibly earning “$20 an hour or more,” to help Americans navigate ObamaCare.

The Department of Health and Human Services (HHS) has proposed a rule laying out the requirements for the healthcare law’s insurance “navigators,” whose job it will be to assist Americans who don’t have coverage through their employers in purchasing insurance through state exchanges. Buying coverage is scheduled to commence in January, but the websites and call centers for the exchanges are supposed to go active October 1, and that’s when the navigators will first be needed. (Of course, those dates could very well be pushed back: The feds’ small-business exchange has already been delayed a year, and HHS is also known to be a few months behind on the state exchanges, many of which it will have to run.)

There is little question that people are going to need a great deal of help finding their way through the labyrinthine legislation. The two laws comprising ObamaCare come to nearly 1,000 pages, and the regulations issued under it are already “well over twice as long as the Guinness World Record for the longest novel,” according to Americans for Limited Government. A draft version of the federal government’s application for insurance is 15 pages long for a family of three and includes an additional 61-page questionnaire for determining eligibility for financial assistance. The proposed navigator rule itself runs to 63 pages.

Just who is eligible to become a navigator? Although the rule declares that navigators “must not have a conflict of interest during their term” and “must provide information and services in a fair, accurate, and impartial manner,” it provides little other guidance. “The rules allow navigators to come from the ranks of unions, health providers and community action groups such as ACORN and Planned Parenthood,” Bedard states. In fact, they require each exchange to have “at least two different types of entities as Navigators, one of which must be a community and consumer-focused non-profit group.”

How many navigators will be needed? The final number has not yet been determined, but according to Bedard, California alone has requested 21,000 of them. It’s no exaggeration to suggest that there may be hundreds of thousands of these tax eaters when all is said and done.

And taxes they will consume. HHS estimates that navigators will make anywhere from $20 to $48 per hour, depending on their positions. Assuming California got its 21,000 navigators and they all made just $20 an hour for a 40-hour week, they would cost taxpayers over $873 million a year — and that’s for just one state. The day after the proposed rule was released, Rep. Kenny Marchant (R-Texas), a member of the House Ways and Means Committee, sent a letter to HHS Secretary Kathleen Sebelius expressing his concern over the navigators’ “inflated hourly wages,” particularly “at a time when thousands of current federal employees are being placed on furloughs to reduce our budget deficit.” (An administration official told Bedard that the $20-per-hour assumption used in the rule “is an estimate, not a recommendation or a requirement” and that “states and organizations are not required by the federal government to set any payment levels for these employees.”)

Additionally, taxpayers will have to foot the bill for translators for non-English-speakers who seek insurance on an exchange. The proposed rule requires exchanges and navigators to “provide consumers with information and assistance in the consumer’s preferred language, at no cost to the consumer, which would include oral interpretation of non-English languages and the translation of written documents in non-English languages when necessary to ensure meaningful access.”

The exchanges themselves are supposed “to have a strong customer-service component, including call centers and physical offices,” according to The Hill. This, too, will undoubtedly take taxpayers for a pretty penny — and provide customer service similar to that of the Internal Revenue Service.

Then there’s the matter of voter registration. The draft ObamaCare application asks the applicant if he would like to register to vote; if so, it directs him to a voter registration form. Republicans are none too happy with this, fearing that it could be used to encourage people to register as Democrats — especially since Democrat-aligned activists may well be serving as navigators — or to retaliate against those who don’t. (Democrats might want to consider this, too: At some point a non-Democrat will move into the White House and become privy to the data HHS has collected.) Rep. Charles Boustany, Jr. (R-La.), chairman of the House Ways and Means Oversight Subcommittee, wrote to Sebelius on March 25, seeking more details on the voter-registration matter. In his letter he reminded her that the Affordable Care Act (ObamaCare) does not mention voter registration and that the Paperwork Reduction Act “requires that Federal agencies gather only appropriate information as required by legislation.”

Navigating ObamaCare is going to be a costly, labor-intensive, intrusive, and politically charged task. In no conceivable way does it improve the quality or reduce the cost of healthcare. It does, however, vastly extend the reach of the federal government and the party that controls its executive branch. And that, more than anything else, explains why the law was passed and why it is proving so difficult to repeal.

Whatever the source of some of the info. in the posted article, there is great concern in the medical world as to just how the system will work when we relatively quickly bring an additional 35-40 million people into the system that otherwise weren't there before.

There was a great episode of "On Point" on NPR a couple weeks ago about this very subject. The show discussed some of the pros and cons of The Affordable Care Act and how much further we can go to address some of the underlying issues with health care delivery in this country. The biggest issue being costs. There's so much more we can do to address what is really the biggest issue with any health care reform effort.

quote:Whatever the source of some of the info. in the posted article, there is great concern in the medical world as to just how the system will work when we relatively quickly bring an additional 35-40 million people into the system that otherwise weren't there before.

quote:Whatever the source of some of the info. in the posted article, there is great concern in the medical world as to just how the system will work when we relatively quickly bring an additional 35-40 million people into the system that otherwise weren't there before.

I know. I work in a part of that world that is doing that very thing.

I have to wonder if this particular issue isn't one more reason why "Medicare for all" may ultimately be the better way to go. Just for the ease of enrollment and for the fact that Medicare is actually quite efficient and cost effective in terms of its administration.

quote:Whatever the source of some of the info. in the posted article, there is great concern in the medical world as to just how the system will work when we relatively quickly bring an additional 35-40 million people into the system that otherwise weren't there before.

I know. I work in a part of that world that is doing that very thing.

I have to wonder if this particular issue isn't one more reason why "Medicare for all" may ultimately be the better way to go. Just for the ease of enrollment and for the fact that Medicare is actually quite efficient and cost effective in terms of its administration.

Some have said that this is the ultimate end game from OC's inception. I work in healthcare as well and as time passes I am not so convinced that they are wrong.

quote:I stopped reading at the part where a supposed expert on the subject refers to ACORN as something that still exists.

Methinks that the "such as" in “The rules allow navigators to come from the ranks of unions, health providers and community action groups such as ACORN and Planned Parenthood" clearly indicates similarity to, not exactly ACORN itself.

quote:I stopped reading at the part where a supposed expert on the subject refers to ACORN as something that still exists.

Methinks that the "such as" in “The rules allow navigators to come from the ranks of unions, health providers and community action groups such as ACORN and Planned Parenthood" clearly indicates similarity to, not exactly ACORN itself.

So you're suggesting that someone shouldn't get the job because of an association they might have or have had with another group? Seems like this was written in a way to rile up conservatives. I'm sure it could also have been written "The rules allow navigators to come from churches and young Republican groups." In reality, as long as they do their job it shouldn't matter what other associations they have.

quote:I stopped reading at the part where a supposed expert on the subject refers to ACORN as something that still exists.

Methinks that the "such as" in “The rules allow navigators to come from the ranks of unions, health providers and community action groups such as ACORN and Planned Parenthood" clearly indicates similarity to, not exactly ACORN itself.

So you're suggesting that someone shouldn't get the job because of an association they might have or have had with another group? Seems like this was written in a way to rile up conservatives. I'm sure it could also have been written "The rules allow navigators to come from churches and young Republican groups." In reality, as long as they do their job it shouldn't matter what other associations they have.

I was just responding to Bhawk, but it's funny how it's the political tilt that makes it's impact with you, and not the utter fiscal insanity behind the whole concept.

Those 30-40 million have recieved medical care long before Obama came in office.
It is called Emergency Room and it is called , Pass to State to Pay and Get Money from Fed Govt.

That system doesn't seem to work well.

I have said it a hundred times, why must we make things hard in our country. Why must the Democrats shoot themselves in the foot? Why don't they learn deceit, skill, plays from the Republicans?

Medical situation in our country, easy.
Medicare, leave as is.
Start phasing it out in lesser amounts, means for those 60 and under.
Same for Soc. Security.
Mediciad , same thing.

Those laid off Americans, tax paying Americans, college aged workin g , tax paying people, etc. who do not have no medical insurance, phase them in Medicare/Medicaid.

Call it Medicare.

Types types of GOVERNMENT RUN MEDICARE/CAID is redundant.

People need, should have medical care. It is Christian. It is neccessary in our country.
People , hard working people PAY for this and they THEY receive nothing.

I am one of those people right now.

Anybody working any kind of job should be allowed , say buy into a private medical insurance at $100.00 a month for a single adult. , person.
Think of the sudent influx of money , stock BC/BS, United HC, Covenat, etc. could make and not have to cover that much. That is the American way for a company. Get lots of money from people and give not much in return. Maybe you cannot have a surgery, but you sure can go for wellness visits, get antibitics , etc.

quote:Whatever the source of some of the info. in the posted article, there is great concern in the medical world as to just how the system will work when we relatively quickly bring an additional 35-40 million people into the system that otherwise weren't there before.

I know. I work in a part of that world that is doing that very thing.

I have to wonder if this particular issue isn't one more reason why "Medicare for all" may ultimately be the better way to go. Just for the ease of enrollment and for the fact that Medicare is actually quite efficient and cost effective in terms of its administration.

Some have said that this is the ultimate end game from OC's inception. I work in healthcare as well and as time passes I am not so convinced that they are wrong.

From a cost control perspective, "Medicare For All" makes a great deal of sense too. I refer you to the recent Time magazine article in which it was suggested, among other things, that if more of our costs were billed at the price that Medicare pays instead of hugely outrageous profit margins no one is aware of or can explain, we'd shave billions per year off our overall costs of healthcare delivery. Would you agree?

quote:I stopped reading at the part where a supposed expert on the subject refers to ACORN as something that still exists.

Methinks that the "such as" in “The rules allow navigators to come from the ranks of unions, health providers and community action groups such as ACORN and Planned Parenthood" clearly indicates similarity to, not exactly ACORN itself.

So you're suggesting that someone shouldn't get the job because of an association they might have or have had with another group? Seems like this was written in a way to rile up conservatives. I'm sure it could also have been written "The rules allow navigators to come from churches and young Republican groups." In reality, as long as they do their job it shouldn't matter what other associations they have.

I was just responding to Bhawk, but it's funny how it's the political tilt that makes it's impact with you, and not the utter fiscal insanity behind the whole concept.

quote:Whatever the source of some of the info. in the posted article, there is great concern in the medical world as to just how the system will work when we relatively quickly bring an additional 35-40 million people into the system that otherwise weren't there before.

I know. I work in a part of that world that is doing that very thing.

I have to wonder if this particular issue isn't one more reason why "Medicare for all" may ultimately be the better way to go. Just for the ease of enrollment and for the fact that Medicare is actually quite efficient and cost effective in terms of its administration.

Some have said that this is the ultimate end game from OC's inception. I work in healthcare as well and as time passes I am not so convinced that they are wrong.

From a cost control perspective, "Medicare For All" makes a great deal of sense too. I refer you to the recent Time magazine article in which it was suggested, among other things, that if more of our costs were billed at the price that Medicare pays instead of hugely outrageous profit margins no one is aware of or can explain, we'd shave billions per year off our overall costs of healthcare delivery. Would you agree?

Yes, I agree, in principal. IMO, had these types of steps (meaning, addressing the specific problem areas within the current system itself) been taken in lieu of trying to overhaul the entire system, we would have been in a better position to afford it, the bureaucracy and the associated cost, wouldn't have ballooned to the extent that it has and we wouldn't have to take 700+ billion out of our current medicare budget.

quote:Whatever the source of some of the info. in the posted article, there is great concern in the medical world as to just how the system will work when we relatively quickly bring an additional 35-40 million people into the system that otherwise weren't there before.

I know. I work in a part of that world that is doing that very thing.

I have to wonder if this particular issue isn't one more reason why "Medicare for all" may ultimately be the better way to go. Just for the ease of enrollment and for the fact that Medicare is actually quite efficient and cost effective in terms of its administration.

Some have said that this is the ultimate end game from OC's inception. I work in healthcare as well and as time passes I am not so convinced that they are wrong.

From a cost control perspective, "Medicare For All" makes a great deal of sense too. I refer you to the recent Time magazine article in which it was suggested, among other things, that if more of our costs were billed at the price that Medicare pays instead of hugely outrageous profit margins no one is aware of or can explain, we'd shave billions per year off our overall costs of healthcare delivery. Would you agree?

If Medicare for all is the answer, then why - even with the lower prices Medicare is willing to pay - is Medicare going broke faster than any other entitlement? We've heard that numerous times from sources left and right, and from the President down. It would appear that Medicare needs some serious help prior to expanding it's reach.

Conceptually I believe we need two systems. Something Medicare-like, where all individuals who can not qualify for a normal insurance option (the elderly, anyone with a diagnosed permanent condition, etc.) are cared for. This would be paid for by a payroll tax, just like the current Medicare deduction, but probably far higher to reflect true costs. If we say that as a society we want care for all, then the costs for those who need the most care should be clear.

The second part for everyone else is free-market insurance coverage bought by each individual. Employers need to get out of the role of health care middle man - they have enough to worry about running their business. Insurance companies need to compete for and satisfy the health care customer just like they do for all other insurance products sold. Conversely, the insurer shouldn't be told they must cover pre-existing, permanent conditions. That's not insurance. Can you buy home insurance after your house burns down? Of course not. People with those situations should be place in the national system, and those for whom normal actuarial insurance rules apply should be able to buy what they want, having a wide choice of competing providers.

Just wait till the 20 and 30 something's who get dumped into the exchanges realize that to meet Obamacare minimums, their insurance costs will be $8,000-10,000/yr. because the system needs them to pay for stuff most will never use in order to work. The generational battle at the polls should be interesting. The progressive answer will no doubt be to delay maturity even longer by letting them stay on their parents insurance till they're 40.

quote:I stopped reading at the part where a supposed expert on the subject refers to ACORN as something that still exists.

Methinks that the "such as" in “The rules allow navigators to come from the ranks of unions, health providers and community action groups such as ACORN and Planned Parenthood" clearly indicates similarity to, not exactly ACORN itself.

So you're suggesting that someone shouldn't get the job because of an association they might have or have had with another group? Seems like this was written in a way to rile up conservatives. I'm sure it could also have been written "The rules allow navigators to come from churches and young Republican groups." In reality, as long as they do their job it shouldn't matter what other associations they have.

I was just responding to Bhawk, but it's funny how it's the political tilt that makes it's impact with you, and not the utter fiscal insanity behind the whole concept.

Consider this, though. Whether it's navigators or something else, the entire world of healthcare is getting ready to explode anyway. Public or private sector, the employment needs to take care of the largest elderly demographic in the history of our country are staggering. I don't think many people fully grasp the impact that the aging of the Baby Boomers is going to have. 78 million people.

It's quite easy to apply high overview thoretical economic solutions to this issue that fit a particular set of political or ideological beliefs. It's quite hard to turn those into real life solutions and actions. This is not about houses or cars or the latest gadget. This is about people's lives. Before you try and upbraid me for bringing emotion into it, I say that this is the one area where emotion cannot be removed.

quote:Something Medicare-like, where all individuals who can not qualify for a normal insurance option (the elderly, anyone with a diagnosed permanent condition, etc.) are cared for. This would be paid for by a payroll tax, just like the current Medicare deduction, but probably far higher to reflect true costs. If we say that as a society we want care for all, then the costs for those who need the most care should be clear.

Are you supporting a massive tax increase here?

quote: Insurance companies need to compete for and satisfy the health care customer just like they do for all other insurance products sold. Conversely, the insurer shouldn't be told they must cover pre-existing, permanent conditions. That's not insurance. Can you buy home insurance after your house burns down? Of course not. People with those situations should be place in the national system, and those for whom normal actuarial insurance rules apply should be able to buy what they want, having a wide choice of competing providers.

Again, this isn't about buying a house or going to Aldi for cheaper groceries. An insurance company, any company, is in business primarily to make money. There is nothing wrong with that. However, when it comes to healthcare, that part of our lives is so completely different.

My parents' house had a fire about ten years ago. What did their insurance company do? Everything they could to keep their payout on the claim as low as possible, right before canceling the policy altogether after my folks had to negotiate every last penny out of them. Sure, they have the free market choice on picking a new home insurance provider, but the free market can't help you in the middle of the claims process.

quote:Something Medicare-like, where all individuals who can not qualify for a normal insurance option (the elderly, anyone with a diagnosed permanent condition, etc.) are cared for. This would be paid for by a payroll tax, just like the current Medicare deduction, but probably far higher to reflect true costs. If we say that as a society we want care for all, then the costs for those who need the most care should be clear.

Are you supporting a massive tax increase here?

quote: Insurance companies need to compete for and satisfy the health care customer just like they do for all other insurance products sold. Conversely, the insurer shouldn't be told they must cover pre-existing, permanent conditions. That's not insurance. Can you buy home insurance after your house burns down? Of course not. People with those situations should be place in the national system, and those for whom normal actuarial insurance rules apply should be able to buy what they want, having a wide choice of competing providers.

Again, this isn't about buying a house or going to Aldi for cheaper groceries. An insurance company, any company, is in business primarily to make money. There is nothing wrong with that. However, when it comes to healthcare, that part of our lives is so completely different.

My parents' house had a fire about ten years ago. What did their insurance company do? Everything they could to keep their payout on the claim as low as possible, right before canceling the policy altogether after my folks had to negotiate every last penny out of them. Sure, they have the free market choice on picking a new home insurance provider, but the free market can't help you in the middle of the claims process.

As to the tax increase; I think we're very wrong to not make the full costs obvious so that the citizens know exactly what they are paying for and how much. We have an entire tax system riddled with obfuscation. If we say we want a national system to care for those who can't afford to care for themselves, or no longer fit into categories of normal insurability, then lets create that and pay for it in a way that is clear, exclusive, and not subject to political games or re-definition.

And I realize that insurer's of health care, or any coverage, are profit-driven by their nature. It can equally be said that govt-run programs are waste producing by theirs. These mutual realities tend to cancel each other out in our country, at least currently. Medicare's huge waste is roughly the same percentage of cost as a private insurer's administration expense which polices out waste.

There'd clearly have to be rules. But if a national system is there to accept those with long-term and permanent needs, then definitions could be created about line between the insurer's limit of responsibility and when the individual goes on (or comes off) the national system.

I refuse to believe that some free-market elements to health care can't help with costs. So far, no political solution has. Obamacare is placing a mountain of rules and requirements on top of an industry that was already one of the most regulated in existence. That always means higher cost.

quote:I stopped reading at the part where a supposed expert on the subject refers to ACORN as something that still exists.

Methinks that the "such as" in “The rules allow navigators to come from the ranks of unions, health providers and community action groups such as ACORN and Planned Parenthood" clearly indicates similarity to, not exactly ACORN itself.

So you're suggesting that someone shouldn't get the job because of an association they might have or have had with another group? Seems like this was written in a way to rile up conservatives. I'm sure it could also have been written "The rules allow navigators to come from churches and young Republican groups." In reality, as long as they do their job it shouldn't matter what other associations they have.

I was just responding to Bhawk, but it's funny how it's the political tilt that makes it's impact with you, and not the utter fiscal insanity behind the whole concept.

quote:Something Medicare-like, where all individuals who can not qualify for a normal insurance option (the elderly, anyone with a diagnosed permanent condition, etc.) are cared for. This would be paid for by a payroll tax, just like the current Medicare deduction, but probably far higher to reflect true costs. If we say that as a society we want care for all, then the costs for those who need the most care should be clear.

Are you supporting a massive tax increase here?

quote: Insurance companies need to compete for and satisfy the health care customer just like they do for all other insurance products sold. Conversely, the insurer shouldn't be told they must cover pre-existing, permanent conditions. That's not insurance. Can you buy home insurance after your house burns down? Of course not. People with those situations should be place in the national system, and those for whom normal actuarial insurance rules apply should be able to buy what they want, having a wide choice of competing providers.

Again, this isn't about buying a house or going to Aldi for cheaper groceries. An insurance company, any company, is in business primarily to make money. There is nothing wrong with that. However, when it comes to healthcare, that part of our lives is so completely different.

My parents' house had a fire about ten years ago. What did their insurance company do? Everything they could to keep their payout on the claim as low as possible, right before canceling the policy altogether after my folks had to negotiate every last penny out of them. Sure, they have the free market choice on picking a new home insurance provider, but the free market can't help you in the middle of the claims process.

As to the tax increase; I think we're very wrong to not make the full costs obvious so that the citizens know exactly what they are paying for and how much. We have an entire tax system riddled with obfuscation. If we say we want a national system to care for those who can't afford to care for themselves, or no longer fit into categories of normal insurability, then lets create that and pay for it in a way that is clear, exclusive, and not subject to political games or re-definition.

And I realize that insurer's of health care, or any coverage, are profit-driven by their nature. It can equally be said that govt-run programs are waste producing by theirs. These mutual realities tend to cancel each other out in our country, at least currently. Medicare's huge waste is roughly the same percentage of cost as a private insurer's administration expense which polices out waste.

There'd clearly have to be rules. But if a national system is there to accept those with long-term and permanent needs, then definitions could be created about line between the insurer's limit of responsibility and when the individual goes on (or comes off) the national system.

I refuse to believe that some free-market elements to health care can't help with costs. So far, no political solution has. Obamacare is placing a mountain of rules and requirements on top of an industry that was already one of the most regulated in existence. That always means higher cost.

Although you make some very solid points here, health care is different from every other product in that everyone needs it. If you don't have insurance, everyone else ends up paying for it anyway in the most expensive way possible - by getting routine care from the ER. Also, most people don't get to shop for their insurance company - they get whatever plan their employer offers. And if private insurance/market forces were so good at holding down costs, then how come Americans pay more for health care than every other industrialized country on earth? It certainly isn't because we get better care here, because clearly we do not!

I'm really not happy about Obamacare either, and clearly rates for many if not most people will be going up. But the system we already had wasn't working at all either. I'd prefer something more like what Canada and most of Europe has. In general, they get better care at lower costs.

quote: And if private insurance/market forces were so good at holding down costs, then how come Americans pay more for health care than every other industrialized country on earth?

The answer to this is simple: just because we have private insurers doesn't mean they are allowed to operate under normal actuarial rules or relatively free-market principle. For decades, govt has layered regulation after restriction on the insurers, limiting everything they can do. No doubt rules are necessary, but they tend to add to cost. I'll post an article below to point out the kind of rule-making insanity I mean.

Maybe I have this wrong, but from a health coverage perspective, there seems to be two kinds of people. Those with normal health conditions that fit into the kind actuarial models insurance serves well. And those who either have serious long term or permanent conditions, or the elderly, who do not fit an insurable model. I just suggest we design solutions along those same lines. Private insurance for the first group bought by the individual, and a tax-funded social system for the latter group.

Here's the kind of rule making I find infuriating, as it relieves the individual from responsibility for their own behavior and raises costs for all...

quote: Insurers can’t charge more for smokers in health exchanges

The board charged with implementing federal health care reforms in the District has voted to prohibit insurance companies from charging higher premiums to cigarette smokers, adding the city to a handful of states rejecting such surcharges because of the effect they have on poor families who are more likely to smoke.

Dr. Mohammad N. Akhter, chairman of the city’s health exchange board, said the costs of the surcharge could be prohibitive for poor families. The Affordable Care Act allows states to impose up to a 50 percent surcharge for people who have used tobacco at least four times a week over the last six months.

A June 2012 study by the Institute for Health Policy Solutions estimated that the largest effect would be on older couples whose earnings were at 150 percent of the federal poverty line. If subjected to the maximum surcharge, a couple older than 60 years old who both smoke would face a premium equaling 48 percent of their total income and 143 percent of their income above the poverty level.

“That’s basically unaffordable,” Dr. Akhter said.

An estimated 20.8 percent of D.C. adults smoke regularly, compared to a national median of 21.2 percent, according to 2011 statistics from the Centers for Disease Control and Prevention. But smoking rates among black residents in the District were much higher, at 30.8 percent.

States have the option to lower or eliminate the surcharge, and Dr. Akhter said board members considered dropping the surcharge from 50 percent to 20 percent or applying the surcharge at 400 percent of the federal poverty level. In the end, the seven-member board voted 5-1 with one member absent to eliminate it entirely.

“We didn’t really want to segment the population too much,” he said.

The purpose of the surcharge was to cover the costs of medical treatment for smoking-related diseases amid concerns that without it premiums for the general population will rise.

Dr. Akhter said the goal of the exchange is to serve as many people as possible, so he did not want to discourage people from buying insurance. He said that the best way to quit smoking is with medical help, and that if people either don’t get insurance or lie about their smoking habits they could be cutting themselves off from treatment options.

Tobacco manufacturer Altria Group Inc., which owns Philip Morris USA Inc., has lobbied against the surcharge, as have the American Lung Association and the American Cancer Society.

David Woodmansee, associate director of state and local campaigns for the American Cancer Society, applauded the move.

“Just because people have become addicted to a terrible drug is not a reason to turn our back on them in providing health care,” he said, noting that low-income people are more likely to smoke.

“This is the population that needs health care the most,” he said. “We are antismoking for sure, but we are not antismoker.”

Mr. Woodmansee said that, in the long run, providing smoking-cessation treatment options that are covered by insurance would lead to more people quitting and reduce premiums for everyone. He predicted that four or five other states in coming weeks might take action similar to that in the District.

Before the Affordable Care Act, five states prohibited smoking premium for individuals and 13 states banned it in small group plans, Mr. Woodmansee said.

The city’s exchange — a Web-based program, akin to the Expedia travel website, with side-by-side comparisons of health plans taking the place of flights or hotel rooms — is set to be operational by October. The board decided last October that the exchange would be the sole health insurance marketplace for individuals and small employers — defined as companies with 50 or fewer workers. The city’s exchange is projected to have more than 100,000 customers.

quote: And if private insurance/market forces were so good at holding down costs, then how come Americans pay more for health care than every other industrialized country on earth?

The answer to this is simple: just because we have private insurers doesn't mean they are allowed to operate under normal actuarial rules or relatively free-market principle. For decades, govt has layered regulation after restriction on the insurers, limiting everything they can do. No doubt rules are necessary, but they tend to add to cost. I'll post an article below to point out the kind of rule-making insanity I mean.

Maybe I have this wrong, but from a health coverage perspective, there seems to be two kinds of people. Those with normal health conditions that fit into the kind actuarial models insurance serves well. And those who either have serious long term or permanent conditions, or the elderly, who do not fit an insurable model. I just suggest we design solutions along those same lines. Private insurance for the first group bought by the individual, and a tax-funded social system for the latter group.

Here's the kind of rule making I find infuriating, as it relieves the individual from responsibility for their own behavior and raises costs for all...

quote: Insurers can’t charge more for smokers in health exchanges

The board charged with implementing federal health care reforms in the District has voted to prohibit insurance companies from charging higher premiums to cigarette smokers, adding the city to a handful of states rejecting such surcharges because of the effect they have on poor families who are more likely to smoke.

Dr. Mohammad N. Akhter, chairman of the city’s health exchange board, said the costs of the surcharge could be prohibitive for poor families. The Affordable Care Act allows states to impose up to a 50 percent surcharge for people who have used tobacco at least four times a week over the last six months.

A June 2012 study by the Institute for Health Policy Solutions estimated that the largest effect would be on older couples whose earnings were at 150 percent of the federal poverty line. If subjected to the maximum surcharge, a couple older than 60 years old who both smoke would face a premium equaling 48 percent of their total income and 143 percent of their income above the poverty level.

“That’s basically unaffordable,” Dr. Akhter said.

An estimated 20.8 percent of D.C. adults smoke regularly, compared to a national median of 21.2 percent, according to 2011 statistics from the Centers for Disease Control and Prevention. But smoking rates among black residents in the District were much higher, at 30.8 percent.

States have the option to lower or eliminate the surcharge, and Dr. Akhter said board members considered dropping the surcharge from 50 percent to 20 percent or applying the surcharge at 400 percent of the federal poverty level. In the end, the seven-member board voted 5-1 with one member absent to eliminate it entirely.

“We didn’t really want to segment the population too much,” he said.

The purpose of the surcharge was to cover the costs of medical treatment for smoking-related diseases amid concerns that without it premiums for the general population will rise.

Dr. Akhter said the goal of the exchange is to serve as many people as possible, so he did not want to discourage people from buying insurance. He said that the best way to quit smoking is with medical help, and that if people either don’t get insurance or lie about their smoking habits they could be cutting themselves off from treatment options.

Tobacco manufacturer Altria Group Inc., which owns Philip Morris USA Inc., has lobbied against the surcharge, as have the American Lung Association and the American Cancer Society.

David Woodmansee, associate director of state and local campaigns for the American Cancer Society, applauded the move.

“Just because people have become addicted to a terrible drug is not a reason to turn our back on them in providing health care,” he said, noting that low-income people are more likely to smoke.

“This is the population that needs health care the most,” he said. “We are antismoking for sure, but we are not antismoker.”

Mr. Woodmansee said that, in the long run, providing smoking-cessation treatment options that are covered by insurance would lead to more people quitting and reduce premiums for everyone. He predicted that four or five other states in coming weeks might take action similar to that in the District.

Before the Affordable Care Act, five states prohibited smoking premium for individuals and 13 states banned it in small group plans, Mr. Woodmansee said.

The city’s exchange — a Web-based program, akin to the Expedia travel website, with side-by-side comparisons of health plans taking the place of flights or hotel rooms — is set to be operational by October. The board decided last October that the exchange would be the sole health insurance marketplace for individuals and small employers — defined as companies with 50 or fewer workers. The city’s exchange is projected to have more than 100,000 customers.

That article talks about what's coming up, not what has happened in the past that has made our health care costs so high. Historically, insurance companies have refused to cover high risk persons, pre-existing conditions, etc. This still hasn't kept health care costs down. Our costs are already higher than countries that provide everyone with health care, regardless of their condition.

All I know is what we have now sucks! Obamacare is going to suck too. I'm just not sure yet which is going to suck more yet. Other countries that have single payer system seem to have better care at a lower cost. Since health care is something every single person needs, it seems like a better idea to use a model that seems to work where it is used. Does everyone in Canada or England love their healthcare? No, but most of them are much happier with the system they have than the system we have. I have several Canadian friends and my wife has lots of Canadian relatives. Not one of them would trade their system for ours.

Fujrich
If Medicare for all is the answer, then why - even with the lower prices Medicare is willing to pay - is Medicare going broke faster than any other entitlement? We've heard that numerous times from sources left and right, and from the President down. It would appear that Medicare needs some serious help prior to expanding it's reach.

Conceptually I believe we need two systems. Something Medicare-like, where all individuals who can not qualify for a normal insurance option (the elderly, anyone with a diagnosed permanent condition, etc.) are cared for. This would be paid for by a payroll tax, just like the current Medicare deduction, but probably far higher to reflect true costs. If we say that as a society we want care for all, then the costs for those who need the most care should be clear.

The second part for everyone else is free-market insurance coverage bought by each individual. Employers need to get out of the role of health care middle man - they have enough to worry about running their business. Insurance companies need to compete for and satisfy the health care customer just like they do for all other insurance products sold. Conversely, the insurer shouldn't be told they must cover pre-existing, permanent conditions. That's not insurance. Can you buy home insurance after your house burns down? Of course not. People with those situations should be place in the national system, and those for whom normal actuarial insurance rules apply should be able to buy what they want, having a wide choice of competing providers.

Just wait till the 20 and 30 something's who get dumped into the exchanges realize that to meet Obamacare minimums, their insurance costs will be $8,000-10,000/yr. because the system needs them to pay for stuff most will never use in order to work. The generational battle at the polls should be interesting. The progressive answer will no doubt be to delay maturity even longer by letting them stay on their parents insurance till they're 40.

A payroll tax.
More money being taken out of our, mine anyway, paycheck. So much is taken out, pardon my ignornce, but I don't even look at gross vs. net and all that is taken out which is NOT for me.

Free market insurance.
Well, with you job , you pick which plan and which insurance compnay is best for you. That is sort of free market.
Health care insurance companies can offer lower rates for those who are part of a big group such as police department, city workers, public school teachers, etc.
If you pay on your own to a company, BC/BS, United, Covenant, etc., it costs a few hundred, amybe $600.00 or more a month.

I think for those who are laid off, in college in early 20's, small business staff, etc., maybe buy a low rate paln with private insurance at , say $100.00 a month. Maybe he cannot cover major things, but it can work in wellness appointmnets, flue/cold meds, etc.

A helath insurance not covering preexisitng conditions...so in other words, these working folks can buy , accept offers from the state instead of private insurance from their jobs and go to the country hospital, the inner city clinic and spend the day there , maybe up to two days LOL,. No.
Would you want that?

Oh no, Fuj. I forgot you are and will be forever perfectly healthy...no conver, have surgery, etc. which happens to Liberals and you can afford to pay COBRA or out of pocket a few hundred a month .

I have said it many times; we need national health care with the option to buy into higher levels of care. Until the populace is welling to let sick people turned away without care if they can't afford it anything else is a sham. It is unfair to expect hospitals and doctors to clean up the mess at the last seconds. No other profession or business is expected to do so - and those who are under or uninsured just get sicker and sicker accentuationg the vicious cycle

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